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Managing Pain


Nonsteroidal anti-inflammatory drugs (NSAIDs) are a pharmaceutical method of reducing the inflammatory symptoms of endometriosis. Much of the pain from endometriosis, specifically menstrual pain, is caused by an excessive production of prostaglandins. Prostaglandins have beneficial effects including enhancing immune function, blocking inflammation, relaxing muscles, etc, however they also have their fair share of detrimental effects, which include the production of inflammation. NSAIDs work to block the production of these prostaglandins and with a generally low cost, accessibility, and minimal side-effects, it is the primary recommendation for the treatment of menstrual cramping. Because the tissue associated with endometriosis is responsive to hormonal cycles, contraceptive hormonal therapy is often paired with NSAIDs to reduce pain.

NSAIDs come in several different brands and levels of accessibility, whether it be over-the-counter or prescription-based. Therefore, it can be difficult to predict the proper NSAID for you, and thus proper medical surveillance and follow-up is necessary to ensure the most optimal maintenance. For women who wish for conception, NSAIDs can be used without the pairing of contraceptive hormonal therapy. NSAIDs can often be used ineffectively due to brand diversity and lack in knowledge of how they work to block pain, so you may have found unsatisfactory results in the past.

For women who are willing to also take contraceptive therapy for treatment, options can expand from estrogen-progestin contraceptives, progestins (for women who prefer to avoid the previous), gonadotropin-releasing hormone (GnRH) agonists, and GnRH antagonists. Danazol, while effective at treating endometriosis-related pain, comes with its own series of androgenic side effects, including acne, muscle cramps, weight gain, etc, so it is not commonly used.

Aromatase inhibitors are also reserved for women with severe pain due to their side effects of bone loss and ovarian follicular cyst development with prolonged use. Because of this, it is often paired with GnRH agonist or an oral estrogen-progestin contraceptive to reduce follicular development.

At NY Robotic Gynecology, we will ensure a thorough explanation and the pros and cons of each product before prescription. Based on the severity of your pain, the degree of development in your endometriosis, and your personal preferences to treatment direction, we will make sure to take everything into account before making any decisions. Together, with our team, you may access the risks and benefits of each option to assure an individualized treatment pattern designed just for you.

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